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Observational Study
. 2019 Jan;22(1):41-49.
doi: 10.1089/jpm.2018.0092. Epub 2018 Oct 25.

Communication Differences between Oncologists and Palliative Care Clinicians: A Qualitative Analysis of Early, Integrated Palliative Care in Patients with Advanced Cancer

Teresa Hagan Thomas  1 , Vicki A Jackson  2   3 , Heather Carlson  2 , Simone Rinaldi  2   3 , Angela Sousa  2 , Andrea Hansen  2 , Mihir Kamdar  2   3 , Juliet Jacobsen  2   3 , Elyse R Park  2   3 , William F Pirl  3   4 , Jennifer S Temel  2   3 , Joseph A Greer  2   3
Affiliations
Observational Study

Communication Differences between Oncologists and Palliative Care Clinicians: A Qualitative Analysis of Early, Integrated Palliative Care in Patients with Advanced Cancer

Teresa Hagan Thomas et al. J Palliat Med. 2019 Jan.

Abstract

Background: Growing evidence demonstrates the benefits of early, integrated palliative care (PC) for patients with advanced cancer and their caregivers. Yet, data are lacking on the communication patterns within this model of care.

Objective: The goals of this study were to describe the content of patient-clinician discussions among patients receiving PC and to compare differences in discussion content between oncologists and PC clinicians.

Design: We conducted a qualitative observational analysis.

Setting/subjects: We included patients with incurable lung and esophageal cancer enrolled in a randomized trial of early, integrated PC versus usual oncology care. We analyzed 68 audio-recorded clinic visits (34 oncologist visits; 34 PC clinician visits) immediately after patients' (N = 19) first and second cancer progressions. We examined themes of clinician communication, comparing the content and frequency of discussions between oncologists and PC clinicians.

Results: Although both oncology and PC clinicians discussed symptom management, medical understanding, and treatment decision making with patients at nearly all postprogression visits, PC clinicians tended to assess patient understanding of the treatment process and prognosis more often than oncologists. PC clinicians addressed patient coping, caregiver experiences and needs, and advance care planning more frequently than oncologists.

Conclusion: PC clinicians play a distinct, complementary role to oncologists in providing care for patients with advanced cancer and their caregivers. PC clinicians tend to assess and elaborate on patient understanding of prognosis and treatment and emphasize effective coping, caregiver needs, and advance care planning. These results illuminate the communication elements by which early, integrated PC may improve patient and caregiver outcomes.

Keywords: advanced cancer; communication; neoplasms; palliative care; quality of life.

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Conflict of interest statement

J.S.T. and J.A.G. have received research funding for a separate study from Pfizer. Kamdar has a consulting and advisory role in addition to stock/ownership in Amorsa Therapeutics. All other authors have no competing financial interests.

NIH/NCI: K24 CA181253 (J.S.T.); NIH/NINR: R01 NR012735 (J.S.T.).

Figures

<b>FIG. 1.</b>
FIG. 1.
Clinic visit audio-recording scheme.
<b>FIG. 2.</b>
FIG. 2.
Frequency of six major topics by clinician type.
<b>FIG. 3.</b>
FIG. 3.
Frequency of medical understanding topic elements by clinician type.
<b>FIG. 4.</b>
FIG. 4.
Treatment decision-making topic elements by clinician type.
See this image and copyright information in PMC

References

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